Provider Demographics
NPI:1235861055
Name:SARA KOHEN DEAN DMD PLLC
Entity Type:Organization
Organization Name:SARA KOHEN DEAN DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-672-2590
Mailing Address - Street 1:106 N OLD KINGS RD STE A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5177
Mailing Address - Country:US
Mailing Address - Phone:386-672-2590
Mailing Address - Fax:386-672-9041
Practice Address - Street 1:106 N OLD KINGS RD STE A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5177
Practice Address - Country:US
Practice Address - Phone:386-672-2590
Practice Address - Fax:386-672-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty